Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Indagine sugli interventi di sostegno alle imprese in Piemonte. Rapporto 2003

Collana monografie. Obiettivo crescer

Role of the cerebellum in high stages of motor planning hierarchy

Motor planning is not a monolithic process, and distinct stages of motor planning are responsible for encoding different levels of abstractness. However, how these distinct components are mapped into different neural substrates remains an open question. We studied one of these high-level motor planning components, defined as second-order motor planning, in a patient (R.G.) with an extremely rare case of cerebellar agenesis but without any other cortical malformations. Second-order motor planning dictates that when two acts must be performed sequentially, planning of the second act can influence execution of the first. We used an optoelectronic system for kinematic analysis to compare R.G.â\u80\u99s performance with age-matched controls in a second-order motor planning task. The first act was to reach for an object, and the second was to place it into a small or large container. Our results showed that despite the expected difficulties in fine-motor skills, second-order motor planning (i.e., the ability to modulate the first act as a function of the nature of the second act) was preserved even in the patient with congenital absence of the cerebellum. These results open new intriguing speculations about the role of the cerebellum in motor planning abilities. Although prudence is imperative when suggesting conclusions made on the basis of single-case findings, this evidence suggests fascinating hypotheses about the neural circuits that support distinct stages of the motor planning hierarchy, and regarding the functional role of second-order motor planning in motor cognition and its potential dysfunction in autism. NEW & NOTEWORTHY Traditionally, the cerebellum was considered essential for motor planning. By studying an extremely rare patient with cerebellar agenesis and a group of neurotypical controls, we found that high stages of the motor planning hierarchy can be preserved even in this patient with congenital absence of the cerebellum. Our results provide interesting insights that shed light on the neural circuits supporting distinct levels of motor planning. Furthermore, the results are intriguing because of their potential clinical implications in autism

Surgical treatment of ruptured intracranial aneurysms: Timing of treatment and outcome

Background: Patients with ruptured intracranial aneurysm should be treated as early as possible, ideally in the first three days post-hemorrhage. However, in countries like Brazil, these patients are usually not admitted to hospital during this period, creating controversies about ideal timing for surgery. Objective: This study evaluated associations between the timing of treatment and the outcomes of patients submitted to clipping of ruptured intracranial aneurysms. Methods: A retrospective investigation about 218 patients, with 251 ruptured aneurysms, submitted to surgery for clipping was conducted. All patients were treated on the day of admission. Regarding the timing of treatment post-hemorrhage, patients were divided into early surgery, treatment on days 1 or 2; intermediate surgery, on days 3–10; and late surgery, >10 days. The grade of subarachnoid hemorrhage on admission was assessed by Hunt and Hess scale. Outcomes on discharge were investigated using the modified Rankin scale and mortality rate. Results: In 102 patients admitted with good clinical grade, 19 showed poor outcomes (mortality rate: 6.8%), while, in 86 patients admitted with poor clinical grade, 50 showed poor outcomes (mortality rate: 27.9%). No statistically significant relationships were verified between the timing of surgery and a poor outcome and mortality, even classifying patients according to aneurysm location and Hunt Hess scale. Conclusion: No statistically significant associations among mortality or poor outcome and timing for surgery were demonstrated. Considering the risks of re-bleeding and hospital stay, the surgical clipping should be considerate as soon as possible in patients with ruptured aneurysms. Keywords: Intracranial aneurysm, Mortality, Subarachnoid hemorrhage, Surgery, Time-to-treatment, Treatment outcom

First report of

Tegumentary Leishmaniasis (TL) in the Brazilian Amazon region is associated with several Leishmania species. In this report, we describe two cases of TL related to Leishmania lindenbergi occurring in different locations of Rondônia state. After clinical diagnosis, lesion samples were collected for parasitological diagnoses via direct microscopic visualization, parasite isolation, and PCR. PCR reactions were positive in both clinical samples. Parasite isolation was possible for both patients, and isolates were submitted to species identification by isoenzyme electrophoresis and DNA sequencing. This report is the first to describe human infections caused by L. lindenbergi since the initial description and record of human infection by this species in 2002

What Difference Do Unions Make?: Their Impact on Productivity and Wages in Latin America

The subject of labor unions in Latin America provokes a variety of diverse and strongly held views. While some see unions as a way to protect workers' rights and ensure an equitable distribution of income, others see unions as a drain of productivity or an intrusion of politics into the workplace. In spite of these strong opinions, the effects of unions in Latin America have received little empirical attention. This book represents one of the first attempts to obtain evidence on union effects in the region. Following an examination of union density across countries, the studies in this volume evaluate the impact of unions on private-sector firm performance, agricultural productivity, and educational outcomes in public school systems. Unions' effects are considered in detail for Argentina, Brazil, Peru and Uruguay, as well as the less-studied case of Guatemala. Some of the findings are surprising and may help provide a basis for policies that better address the concerns of workers, employers and the public at large

What Difference Do Unions Make?: Their Impact on Productivity and Wages in Latin America

The subject of labor unions in Latin America provokes a variety of diverse and strongly held views. While some see unions as a way to protect workers' rights and ensure an equitable distribution of income, others see unions as a drain of productivity or an intrusion of politics into the workplace. In spite of these strong opinions, the effects of unions in Latin America have received little empirical attention. This book represents one of the first attempts to obtain evidence on union effects in the region. Following an examination of union density across countries, the studies in this volume evaluate the impact of unions on private-sector firm performance, agricultural productivity, and educational outcomes in public school systems. Unions' effects are considered in detail for Argentina, Brazil, Peru and Uruguay, as well as the less-studied case of Guatemala. Some of the findings are surprising and may help provide a basis for policies that better address the concerns of workers, employers and the public at large